Exploratory factor analysis on the development and validation of the understanding, attitude, practice and health literacy questionnaire on COVID-19 in Malay language.

Coronavirus Disease 2019 (COVID-19) is an emerging respiratory illness caused by a novel coronavirus known as Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). To effectively assess understanding, attitudes, practices, and health literacy regarding COVID-19, a valid and reliable questionnaire needs to be developed. Therefore, this study aims to develop and validate the Understanding, Attitude, Practice and Health Literacy Questionnaire on COVID-19 (MUAPH C-19) in Malay Language. A cross-sectional study was conducted across three hospitals in Klang Valley from June 20, 2022, to June 30, 2022. The study's target population consisted of Malaysian citizens aged 18 years and older who attended the three hospitals. A systematic random sampling method was employed to select participants. The original MUAPHQ C-19 questionnaire consists of four domains: understanding (12 items), attitude (15 items), practice (11 items), and Health Literacy (12 items). The validity of the questionnaire was assessed using exploratory factor analysis (EFA) and the reliability was assessed using Cronbach's alpha and interclass correlation. A factor loading threshold of 0.50 was set. A Cronbach's alpha value greater than 0.6 was considered acceptable. An intraclass correlation coefficient (ICC) value greater than 0.75 indicated good reliability. A total of 100 respondents participated in the study. The Kaiser-Meyer-Olkin (KMO) Measure of Sampling Adequacy ranged from 0.691 to 0.899, and Bartlett's Test of Sphericity was significant across all domains, indicating sufficient sample adequacy for the EFA. An eigenvalue greater than 1.0 revealed two components in the understanding domain (41.308-68.250%), three components in the attitude domain (22.802-58.973%), four components in the practice domain (19.852-73.500%), and a single component in the health literacy domain (64.194%). In the reliability assessment, Cronbach's alpha ranged from 0.677 to 0.914, while the intraclass correlation ranged from 0.562 to 0.759 across all domains, demonstrating a good and reliable scale. Finally, 10 items have been deleted, and 10 sub-domains have emerged across four domains. This study successfully developed a valid and reliable tool of the 42-item MUAPHQ C-19 for measuring understanding, attitudes, practice and health literacy related to COVID-19 among the general public in Malaysia. Future studies utilizing the MUAPHQ C-19 can be conducted nationwide to monitor public literacy and behaviours regarding COVID-19 and to assess the effectiveness of prevention and control programs implemented.